WI0500191_GEOTHERMAL_20120514

Beverly Eaves Perdue
Governor
Mary Harris
AVA
NCDE~R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
May 14, 2012
446 Simon Harris Road
Henderson, NC 27537
Subject: Notification of Rule Revisions Affecting
Closed-Loop Geothermal Injection Well Permit Holders
Permit Number: WI0500191
Dear Ms. Harris:
Dee Freeman
Secretary
Our records indicate that you currently hold a permit for a closed-loop geothermal injection well
system. This letter is to inform you that on May 1, 2012, the North Carolina Administrative
Code Title 15A Section 2C .0200 entitled "Well Construction Standards -Criteria and
Standards Applicable Injection Wells" were revised. These revisions affect all permits issued
for injection wells including geothermal wells.
This letter is also to inform you that your closed-loop geothermal injection well(s) have become
"permitted by rule." Therefore, you are no longer required to renew your current permit
and the permit will be valid indefinitely as long as the wells are active and are operated in
accordance with the revised rules referenced above. Please keep in mind that if you abandon
the wells, a record of abandonment must be submitted to the Division of Water Quality. You
may view the revised rules on our website at http://portal.ncdenr.org/web/wq/aps.
If you have any questions regarding your current permit or the rule revisions, please feel free to
contact our underground injection control staff at [phone].
Sincerely,
£~·
Eric G. Smith, P.G.
Hydro geologist
cc: UIC Pe r !.lli_f File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
internet: www.ncwaterguality.org
An Equal Opporlunity \ Affirmative Action Employer
One
North Carolina
J\Jat11rnll11
1
TRANSMISSION VERIFICATI❑N REP❑RT
TIME : 09/22/2008 16:37
NAME : NCDE&NR/WATER DUAL
FAX : [phone]
TEL : [phone]
DATE,TIME 09/22 16:33
FAX NC./NAME 93650477
DURATION 00:03:11
PAGE(S) 11
RESULT OK
MODE STANDARD
ECM
4C14,_z_ck 1 matiuk cl (2_7/0

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Coleen H. Sullins, Director
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date:
FAX TO: 0d So1u o t
REF:
( lq )1.1 11
FAX NUMBER: S" v/..1��
FROM: aw a 1r
PHONE: LI Fi%3 " 32.Z i
NO. OF PAGES INCLUDING THIS SHEET:

MVlichael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Coleco H. Sullins, Director
Division of Water Quality
September 13, 2008
Mary B. Harris and John L. Webster
446 Simon Harris Road
Henderson, NC 27537
a
Re: Issuance of Injection Well Permit
Permit No. WI0500191
Issued to Mar} E. Barris and John L. Webster
Dear Ms. Harris and IVIr. Webster:
In accordance with your application received September 3. 2008,1 am forwarding Permit No.
WI0500191 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located 446 Simon Harris Road, Henderson, Vance County, NC
27537. This permit shall be effective from the date of issuance until August 31, 2013, and shall
be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In addition, please
submit copies of the Well Construction Completion form (GW-1) and site map after
construction as required in Part I paragraphs 8 and 9.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit three months prior to its expiration date. As indicated in the
pel mzit, this permit is not transferable to any person without prior notice to, and approval by. the
Director of the Division of Water Quality. If you have any questions regarding your permit or
the Underground Injection Control Program please call Mr. Qu Qi at [phone] or me at
[phone].
Best Regards,
LT,
Michael Rogers, Environmental Specialist
cc: 3av Zimmerman - RRO
Central Office File — WI0500191
Brad Scheel — Home Energy. Inc. (via. fax and USPS)
Vance County Environmental Health Dept.
Attachment( s)
NorthCarolina
;Naturally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone (9I9) 733-3221
Internet: Mir ://www,newateryualit,,.ore 272E Capital Boulevard Raleigh, NC 27604 Fax 1: (9I91715-0588
Fax 2: [phone]
An Equal opportunityJATTirmative Acton Employer— 50% Recydedf1O% Post Consumer Paper Customer Service: (S771623-6748

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
•
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Mary B. Harris and John L. Webster
FOR THE CONSTRUCTION AND OPERATION OF 8 TYPE 5QM INJECTION WELLS,
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed -loop geothermal -mixed -fluid heat pump
system. This system is located at 446 Simon Harris Road, Henderson, Vance County, NC
27537, and will be constructed and operated in accordance with the application dated September
3, 2008, and in conformity with the specifications and supporting data submitted, all of which are
filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the
Water Use Act or any other applicable Laws, Rules, or Regulations. Operation and use of an
injection well shall be in compliance with Title 15A North Carolina Administrative Code 2C
.0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well construction and
use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31.
2013, and shall be subject to the specified conditions and limitations set forth in Parts 1 through
IX hereof:
Permit issued this the 11 day of t.-c , 2008.
m
J))c
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500191 Page 2

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Weil Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94. •
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate
according to 2C .0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section - Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
GW-ls must be submitted within 30 days of completion of well construction. Copies of
the GW-1 form(s) shall be retained on-site and available for inspection.
9 . Well construction records must also be submitted for any existing water supply wells on-
site as well as a site map showing any water supply wells on adjacent properties as
specified in NCAC .021 l(d)(l)(D).
Permit No. WI0500191 Page3
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on-site available
• for inspection. •
2. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the
Aquifer Protection Section's Underground Injection Control (UIC) Program Central Office
staff, telephone number [phone] and the Raleigh Regional Office Aquifer Protection
Section Staff, telephone number [phone].
3 . All underground tubing shall be refrigeration grade copper tubing.
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall-be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via treniie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
10. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable. Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. This testing
data shall be recorded on the attached Mechanical Integrity Test Record Form and
Permit No. WI0500191 Page4
submitted to the Aquifer Protection Section at least 24 (twenty-four) hours prior to the
initiation of the operation of the facility for injection. A copy of this form shall also be
retained on-site for inspection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site (e.g., building foundation comers). The Permittee shall retain a
copy of the triangulation records. The Permittee shall also submit a copy of the
triangulation records to the Aquifer Protection Section within 30 days of completion of
well construction. •
12. The written documentation required in Part II. p araErraphs (1 0) and (1 1) shall be submitted to:
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
_Raleigh, NC 27699-1636
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, c1,s described in the application and other supporting data. ·
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
Permit No. WI0500191 Page 5
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3 . At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166 and the Raleigh Regional Office, telephone number [phone]~ Notification is
required so that Division staff can inspect or otherwise review the injection facility and
determine if it is in compliance with permit conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Raleigh Regional Office, telephone number (919) 791-
4200, any of the following:
Permit No. WI0500191 Page 6
(A) Any occurrence at the injection facility that results m any unusual operating
circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of
proper injection operations, such as mechanical or electrical failures;
(C) Any loss ofrefrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4 . In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall , at least 90 days prior to the expiration of this permit, request an
extension.
PART IX -CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not ·be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
Permit No . WI0500191 Page 7
..
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled .
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well .shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) • The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion
of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Permit No. WI0500191
Aquifer Protection Section-UIC Staff
DENR-Division ofWater Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 8
Mechanical Integrity Test Record
(For 5QM Geothermal Heat Pump Injection Well System)
Owner/Permittee Name: Permit Number: WI __________ __: -'-'--=-------
Facility Address: _____________________________ _
Home Phone: Cell Phone:
Heat Pump Contractor Name: ____________ _, .. '-------------
Office Phone: Cell Phone: -----------------~=-"'-=-"="-'------------
Tester Name: _______________ Signature: ____________ _
Date of Test: --------
Loop Initial Pressure (psi) Final Pressure (psi) Duration
(minutes)
1
2
3
4
5
6
7
.8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Pass (Yes or No)
-------------------------------
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24
hours prior to the initiation of the operation of the facility. You can send the form by mail: UIC Program, Mail
Service Center 1636, Raleigh, NC 27699 orby fax: [phone].
Permit No . WI0500191 Page 9
Loop Initial Pressure (nsi) Final Pressure (nsi) Duration (minutes) Pass (Y es or No)
• ..
I
Permit No. WI0500191 Page 10
Permit Number WI0500191
Program Category
Ground Water
Permit Type
Injection Mixed Fluid GSHP Well System (SQM)
Primary Reviewer
michael. rogers
Permitted Flow
Facilit
Facility Name
Mary B Harris and John L Webster SFR
Location Address
446 Simon Harris Rd
Henderson
Owner
Own·er Name
Mary
Dates/Events
NC 27537
B Harris
Orig Issue
09/13/08
App Received Draft Initiated
09/03/08
Scheduled
Issuance
Central Files: APS_ SWP_
09/17/08
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Brad Scheel
302 E Third St
Wendell
Major/Minor
Minor
Region
Raleigh
County
Vance
Facility Contact Affiliation
OwnerType .
Individual
Owner Affiliation
Mary Harris
446 Simon Harris Rd
Henderson
NC
NC
· Public Notice Issue
09/13/08
·Effective
09/13/08
27591
27537
Expiration
08/31/13
Reg ulated Activities Req uested/Received Events -~---------------------
Heat Pump Injection Region comments on draft requested
Region comments on draft received
Outfall NULL
Waterbody Name Stream Index Number Current Class
09/09/08
09/09/08
Subbasin
Michael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Coleen { Sullins, Director
Division of Water Quality
September 13, 2008
Mary B. Harris and John L, Webster
446 Simon Harris Road
Henderson, NC 27537
Re: Issuance of Injection Well Permit
Permit No. W10500191
Issued to Mary B. Harris and John L. Webster
Dear Ms. Harris and Mr_ Webster:
In accordance with your application received September 3, 2008, I am forwarding Permit No.
WI0500191 for the operation of a vertical closed -loop geothermal mixed -fluid heat pump
injection well system to be located 446 Simon Harris Road, Henderson, Vance County, NC
27537. This permit shall be effective from the date of issuance until August 31.2013, and shall
be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In addition, please
submit copies of the Well Construction Completion form (GW-1) and site map after
construction as required in Part I paragraphs 8 and 9.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit three months prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Quality_ If you have any questions regarding your permit or
the Underground Injection Control Program please call Mr. Qu Qi at [phone] or me at
[phone].
Best Regards,
Michael Rogers, Environmental Specialist
cc: Jay Zimmerman - RRO
Central Office File — WI0500191
Brad Scheel — Home Energy, Inc. (via. fax and USPS)
Vance County Environmental Health Dept.
Attachment(s)
l�� hCarolina
Naturally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 276994636 Telephone: [phone]
Internet: httn:llwww.ncwaterqualitv.org 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affinnative Action Employer-50%Recycled/10% Post Consumer Paper Customer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND ❑PERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
May B. Harris and John L. Webster
FOR THE CONSTRUCTION AND OPERATION OF 8 TYPE 5QM INJECTION WELLS.
defined in Title 15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of
operating a "direct expansion" type vertical closed -loop geothermal -mixed -fluid heat pump
system. This system is located at 446 Simon Harris Road, Henderson, Vance County, NC
27537, and will be constructed and operated in accordance with the application dated September
3, 2008, and in conformity with the specifications and supporting data submitted, all of which are
filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Construction and Operation only, and does not waive any provisions of the
Water Use Act or any other applicable Laws. Rules, or Regulations. Operation and use of an
injection well shall be in compliance with Title 15A North Carolina Administrative Code 2C
.0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well construction and
use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31.
2013, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
Permit issued this the \--1 day of 1 -r , 2008.
abt
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500191 Page 2

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (ISA NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S-. 87-94. • •
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that
are generally subject to flooding include those with concave slope, alluvial or colluvial
soils, gullies, depressions, and drainage ways.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate
according to 2C .0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
GW-1 s must be submitted within 30 days of completion of well construction. Copies of
the GW-1 form(s) shall be retained on-site and available for inspection.
9. Well construction records must also be submitted for any existing water supply wells on-
site as well as a site map showing any water supply wells on adjacent properties as
specified in NCAC .021 l(d)(l)(D).
Permit No. WI0500191 Page 3
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to constructing the injection well system, the Permittee or his agent shall test the pH of
the soil at a depth of three feet at the planned well location. If the resulting soil pH is less
than 6 standard units or greater than 11 standard units, the well system shall be equipped with
a compatible cathodic protection system. All testing results shall be kept on-site available ..
for inspection.
2. At least forty-eight ( 48) hours prior to constructing system, the Permittee shall notify the
Aquifer Protection Section's Underground Injection Control (UIC) Program Central Office
staff, telephone number [phone] and the Raleigh Regional Office Aquifer Protection
Section Staff, telephone number [phone].
3 . All underground tubing shall be refrigeration grade copper tubing.
4. Prior to installation, all tubing to be placed in boreholes ("loops") shall be checked for leaks
by pressurizing the loop to a gage pressure of at least 350 pounds per square inch (psig),
immersing the loop in water and examining it for leaks. Loops with leaks shall not be
installed.
5. Prior to installation, each loop shall be visually inspected for damage such as kinks, dents,
and scrapes. Each loop shall be checked to verify that the nitrogen charge applied to the loop
by the manufacturer before shipping is still present at a pressure of at least 300 psig. The
loop manufacturer shall be notified in the event of damage or pressure loss, and the
manufacturer's instructions shall then be followed. The nitrogen charge may be released
only when the loop is installed and ready to be connected to the manifold.
6. Boreholes shall be large enough to allow insertion of the loop plus a tremie pipe for grouting.
7. After insertion of the tubing into the boreholes, an approved grout (as defined in Title 15A
North Carolina Administrative Code 2C .0100) shall be pumped via tremie pipe into the
annular space of each borehole so as to completely fill it from bottom to top.
8. All tubing junctions shall be brazed using lead-free brazing material. The brazing material
shall have a galvanic potential as close as practicable to that of the tubing material.
9. Dry nitrogen shall be circulated through the tubing during brazing to prevent oxidation.
l 0. After installation and prior to operation of the system, a mechanical integrity test shall be
conducted by pressurizing the injection well system to 400 psig with dry nitrogen and
monitoring for leaks using an ultrasonic or other leak detector of equal sensitivity and
monitoring pressure in the system for at least 2 hours. Alternatively, an equivalent vacuum
test is acceptable. Any pressure fluctuation other than that due to thermal expansion and
contraction of the testing medium shall be considered a failed mechanical integrity test. Any
leaks shall be located and repaired prior to charging the system with refrigerant. This testing
data shall be recorded on the attached Mechanical Integrity Test Record Form and
Permit No. WI0500191 Page4
•
submitted to the Aquifer Protection Section at least 24 (twenty-four) hours prior to the
initiation of the operation of the facility for injection. A copy of this form shall also be
retained on-site for inspection.
11. The location of each of the system manifolds shall be recorded by triangulation from two
permanent features on the site ( e.g., building foundation .corners). The Permittee shall retain a
copy of the triangulation records. The Permittee shall also submit a copy of the
triangulation records to the Aquifer Protection Section within 30 days of completion of ..
well construction. ..
12. The written documentation r eq uired in Part II, p aragrap hs (1 0) and (1 1) shall be submitted to:
Aquifer Protection Section-VIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances, which may be
imposed by other local, state, and federal agencies, which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
Permit No. WI0500191 Page 5
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility .
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval•from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166 and the Raleigh Regional Office, telephone number [phone]. Notification is
required so that Division staff can inspect or otherwise review the injection facility and
determine if it is in compliance with permit conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone , within 48 hours of the occurrence or first
knowledge of the occurrence, to the Raleigh Regional Office, telephone number (919) 791-
4200, any of the following:
PermitNo. WI0500191 Page 6
(A) Any occurrence at the injection facility that results m any unusual operating
circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of
proper injection operations, such as mechanical or electrical failures;
(C) Any loss ofrefrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 90 days prior to the expiration of this permit, request an
extension.
PART IX -CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of
an injection well. Such a change would include the discontinued use of a well for
injection. If a well is taken completely out of service temporarily, the Permittee must
install a sanitary seal. If a well is not to be used for any purpose that well must be
permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well Construction
Standards.
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214 , including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
Permit No. WI0500191 Page 7
..
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled .
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion
of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Permit No. WI0500191
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 8
Mechanical Integrity Test Record
(For SQM Geothermal Heat Pump Injection Well System)
Owner/Permittee Name: Permit Number: WI --------------'-~------
Facility Address: ____________________________ _
Home Phone: Cell Phone:
Heat Pump Contractor .Name: ________________________ _
Office Phone: Cell Phone: -------------------------------
Test er Name: _______________ Signature: ____________ _
Date of Test: --------
Loop Initial Pressure (psi) Final Pressure (psi) Duration
(minutes)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Any additional loop testing add to back of this form
Comments:
Pass (Yes or No)
--------------------------------
Other Test Methods and Results:
This form must be filled out and signed by the tester. The record must be received by Aquifer Protection Section 24
hours prior to the initiation of the operation of the facility. You can send the form by mail: UIC Program, Mail
Service Center 1636, Raleigh, NC 27699 oi-by fax: [phone].
Permit No. WI0500191 Page 9
Loop Initial Pressure (osi) Final Pressure (osi) Duration (minutes) Pass (Yes or No)
•
Permit No. WI0500191 Page 10
Re: New SQM App WI0500191
1 of 1
Subject: Re: New SQM App WI0500191
From: Jay Zimmerman <[e-mail]>
Date: Tue, 09 Sep 2008 13 :3 7: 18 -0400
To: Michael Rogers <[e-mail]>
Go ahead and issue permit.
..
Jay
Michael Rogers wrote:
Jay-
Attached is the draft permit for a new SQM well for
your review. If we don't hear anything thing back by
next Monday, 9/15/08, that you are going to conduct
an inspection, we will go ahead and issue permit.
The scanned App will be sent via another email to
reduce the MB.
·Thanks
S. Jay Zimmerman, L.G.<Jay [e-mail]>
Environmetal Regional Supervisor/ Raleigh Regional Office
DWQ/ Aquifer Protection Section
9/11/2008 8:22 AM
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
Division of Water Quality
September 3, 2008
Mary B. Harris
John L. Webster
446 Simon Harris Road
Henderson, NC 27537
Subject: Acknowledgement of Application No. WI0500191
Mary B Harris and John L Webster SFR
Injection Mixed Fluid GSHP Well System (5QM)
Vance
Dear Mary and John:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials an September 3, 2008. This application package has been assigned the number
listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in
providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final
action by the Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days
after receipt of a complete application.
If you have any questions, please contact Michael Rogers at 919-715.6166, or via e-mail at
[e-mail]. If the reviewer is unavailable, you may leave a message, and they will respond
promptly. Also note that the Division has reorganized. To review our new organizational chart, go to
hn p:flh2o.enr.state.nc.usldocumentsidwq_orgchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely,
OLe&A.&VQ
for Debra J. Watts
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Brad Scheel - Home Energy, Inc., 302 E. Third Street, Wendell, NC 27591
Permit Application File W10500191
No� Carolina
Naturally
Aquifer Protection Section 1636 malt Service Center Raleigh, NC 27699-1636 Telephone: [phone]
Internet: www.ncwaterquality.orq Location: 2728 Capital Boulevard Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
An Equal Opportunity/Affirmative Action Employer- 50% Recycied110%Post Consumer Paper Customer Service: [phone]

ry i' 0 93 Qlj t3 NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR1
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5QM WELL(St
New Permit Application OR - Renewal (check one)
DATE:
PERMIT NO.
. 2o02
(leave blank if NEW permit application)
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or govertyrient agency, state name of
entity and a representative w/authority for signature): M F j4 i�l s 1 h 1) I' �LJdas
( I ) Mailing Address: 11 L Jr ?'1J 0.] gil_oeRL5 ►°C(
City: He _.. State:? ( Zip Code:7.57 County:14%k€
Home/Office Tele No.62 1 - 0(o8 Cell No.: £5- 76 7 -ma,
EMAIL Address. J& h4J [a3 froiA:1.61341-4
(2) Physical Address of Site (if different than above);
City: State: Zip Code: County:
Home/Office Tele No.: Cell No.:
EMAIL Address;
S. AUTHORIZED AGENT OF OWNER., IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate MC well)
Company Name: On' - — —
Contact Person; EMAIL Address:
Address:
City: - State: Zip Code:
Office Tele No.:
Website Address of Company, i f any
C. STATUS OF AP _iCA_NT
Private: (/ Federal:
State:
Commercial:
County:
Ceti No.:
Municipal: Native American Lands:
GPU 1JIC 5QM Well Permit Application (Revised 7/20081
Page I

D. WELL DRILLER INFORMATION
Company Name; ftoh1e. E ner~ ~
Well Drilling Contractor's Name: D l\\/ i a \nt..
___&~........_ ___________ _
NC Contractor Certification No.: _...:2=--.,_1 ~~---------------------
Contact Person: 5rQ a EMAIL Address: b rad 8:tbthom( u,..,. tt ~~ ' 7:T J lDn-\
Address; 0 0o,c J.3 0 ~ f.. ThiYA +·
City: \NfM\Ae{\ Zip Code: 11'5~ I County: -=-\\J(l-=I(=(,,.,__ _______ _
0fficeTeleNo.: 41'\-,31,l,-01-"-_I _ Cell No.: "lltf• tl'15-1t,t:ff>
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
F.
G.
Company Name: _____________________________ _
Contact Person.!...: ______________ !,1.E~M~AIL=C.!.A~d:!.::dri~es=s:'------------
Address: ---------------------------------
City: _________ Zip Code: ____ County: ____________ _
Office Tele No.: Cell No .: _________ _
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
~ a.,o thivmaJ HVAC, " cA os e J k-O vp CD f'pe r:: pi pi 0=3 .
WELL CONSTRUCTION DATA (Ski p to Section H if this is a Permit RENEWAL )
(1) Proposed date to be constructed:_· -04 -Qfb Number of borings : _'{)~--
Approximate depth of each boring (feet): '1:5-+-/_
(2) Chemical additives to be used in closed-loop system ( only those chemicals indicated have been approved):
l2.407C-v"" ~--~propylene glycol ___ ethanol --~~-__ other (other additives will
need prior approval by NCDENR before use}
(3} Type of tubing to be used (copper, PVC, etc): ___CQ{Z_P-,e,._y ___________ _
(4) Well casing. Is the well(s) cased? (check either (a.) YES m: (b.) NO below)
(a) YES ___ if yes, then provide casing information such as~ (steel. PVC. plastic, etc.), diameter,
depth, and extent of casing appearing above ground: ------------~
(b) NO
(5) Grout (material surrounding well casing and/or piping): ~
{a) Grout type: Cement__ Bentonite -~-C Other (specify) ______ _
(b) Grout depth of tubing (reference to land surface): from O to 15 (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
H. INJECTION-RELATED EQUIPMENT
Anach a diagram sho¼ing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GPU t UIC SQM Well Permit Applicati on (Revist.'CI 712008) Page 2
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
11) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump well system. Label ail features clearly and include a north arrow_
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water wetl(s) on the subject property or adjacent properties? 1J YES ,_NO
If Yes, than indicate location on attached map(s).
K. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate tsin girt, repair, and if applicable, aband +n the injection well and
all related appurtenances in accordance with II al py.)(ed spyci)ications . crmit."
1
(—
Lure ot Propert\'Owner/Applicant
rCJOil n L. YII( 'k G(Y, 0 61.p'Yi s
SEP 0a2008
Print or Type Full Name
rnatuo(Property Owner/Applic tt
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Ca nolin a DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mall Service Center
Raleigh, NC 27699-1636
Telephone [phone]
(4,65
GPU-UIC 5QM Well Permit Application tReviied MOOS) Page 3

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